A Bid To Replace Neglect For Tropical Diseases With Attention

An artist on Rio de Janeiro's Copacabana beach puts the final touches on a sand sculpture of the assassin bug, which spreads Chagas disease. The sculpture was part of an event in 2009 commemorating the 100th anniversary of the discovery of the disease.

Tropical diseases that have long been overlooked are getting their due.

An ambitious new push to eradicate, eliminate or control 17 scourges over the next eight years was just unveiled in London. The initiative brings together some of the world's largest drugmakers, health-oriented foundations and nongovernmental organizations. Governments from the developed world and the countries most affected by the diseases are also on board.

The drug companies will donate billions of doses of drugs and open their libraries of experimental medicines to quicken the pace of new drug development.

"We're saying look, if we focus our energies we can make some real progress," says Andrew Witty, the CEO of GlaxoSmithKline tells Shots. "We're serious about making a huge impact in the short run."

Witty says it's the first time that the world's 13 biggest pharmaceutical competitors have agreed to collaborate on a common goal and share their expertise on potential new drugs.

He says the project will lead to something like 1.5 billion free treatments per year to people in Africa. Witty declined to put a dollar figure on the total effort, but it includes almost a half-billion dollars in new funds from foundations and governments, plus the value of donated medicines.

But taken together, these illnesses account for a heavy burden of misery, disability, poverty and death. They afflict 1.4 billion people in the world's poorest countries.

Dr. Mwele Malacela spoke with Shots about the impact of just one disease on her homeland of Tanzania — lymphatic filariasis, sometimes called elephantiasis from the ponderous swellings that disfigure the legs, arms, scrotums and breasts of infected people.

"People with these big growths can hardly do their normal chores, can hardly walk," Malacela says. "Two weeks out of a month they are in bed with fevers. It keeps them in a cycle of poverty."

The disease is caused by tiny worms injected into the blood by mosquito bites. When the worms develop into adults, they block lymph channels, causing huge swellings that can weigh over 100 pounds.

But Malacela says there's a "great possibility" that filariasis can be eliminated from Tanzania and other countries where it's been endemic forever. People who have the disease can't be cured, but if they get the right drug combination, the microscopic larval stage of the worms can be eliminated from the blood.

"We hope we will reach a point where there are no microfilaria in the blood," Malacela says. "Once that happens, when the mosquito bites, there is nothing to transmit and hence the disease is interrupted."

Malacela says authorities hope to bring mass drug treatment to 96 of Tanzania's 123 districts by the end of this year. "That's tremendous progress," she says. "Just a few years we were looking at only about 26 districts."

Lymphatic filariasis is slated for global elimination by 2020, along with blinding trachoma, leprosy and sleeping sickness. That means incidence would be reduced to zero, but continued surveillance and intervention will be required to prevent a resurgence.

Slated for eradication — permanent reduction of worldwide incidence to zero--are dracunculiasis or guinea worm disease, by 2015, and yaws, a bacterial skin infection that can be cured with a single injection of penicillin or azithromycin, by 2020.

The London Declaration, as it's called, calls for elimination in some regions by 2015 of rabies, Chagas disease, river blindness and schistosomiasis. By 2020 regional elimination is scheduled in other areas for these diseases plus the most serious form of the parasitic disease leshmaniasis.

Coupled with recent progress against HIV, polio and development of a vaccine against malaria, this new initiative signals a new optimism about the control or elimination of a wide range of public health scourges.

"I think our confidence level has never been higher," says Glaxo's Witty. "We now have treatment options... good weapons. What you're seeing is the cumulative effect of a great deal of research and great scientific ingenuity."

Malacela, who is director-general of Tanzania's National Institute for Medical Research in Dar es Salaam, says the London conference, which attracted about 300 of the world's experts on neglected tropical diseases, was "a bit emotional."

"It is a period of hope," she says. "Given the difficulties around the world at the moment, one wouldn't have expected to see such enthusiasm about diseases in the developing world."

If someone had told her years ago that it might be feasible to eradicate or eliminate many of these diseases, Malacela says, "I would probably have shaken my head and said that's not possible."